Social determinants of health as a framework to identify and assess cross-sector funding opportunities

Abstract

Objective: To present a content analysis and method for applying a social determinants of health (SDOH) analytical framework to legislation.

Data sources and study setting: Secondary data include 215 sections of the American Rescue Plan Act of 2021 (ARPA) and related information from federal government websites (e.g., press releases, notices of funding announcements, and funding tables).

Study design: Researchers conducted a qualitative content analysis of legislative text, recording all sections, appropriations, allocations, and administrators. Using an SDOH analytical framework defined by Healthy People 2030, researchers coded each section, appropriation, and allocation within the legislation.

Data collection/extraction methods: Researchers reviewed all ARPA sections, appropriations, and allocations separately, resulting in 328 entries. Descriptive characteristics were calculated using Tableau and Microsoft Excel. Researchers coded each appropriation or allocation using definitions and key words presented in the SDOH analytical framework.

Principal findings: Applying an SDOH analytical framework to the legislation's funding amounts reveals an overlap of investment opportunities that cross-sector initiatives can leverage. This overlap is seen primarily in two ways: (1) specific allocations and appropriations that can be used to meet multiple SDOH goals and (2) federal administrators receiving money that can be categorized according to multiple SDOHs. For example, approximately 99% of tracked ARPA funds can be used to support one or more SDOHs. Thirty-five appropriations or allocations can support programs categorized for more than one SDOH category. Eight departments received funds that could be designated for two or more SDOHs. All five SDOH categories can potentially receive funding from 3 to 11 federal administrators.

Conclusions: Using an SDOH analytical framework is an innovative approach to conceptualizing and synthesizing the contents of complex legislation. This approach demonstrates funding patterns across SDOH that can encourage cross-sector collaborations. Future content analysis of legislation can employ this SDOH framework to demonstrate cross-sector initiative funding opportunities.

Keywords: aligning; cross-sector; health equity; health policy/politics/law/regulation; integrated delivery systems; qualitative research; social determinants of health.